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HHS Moves One Step Closer to Modernizing Medicare Payments

On April 27, 2016, the Department of Health & Human Services issued a proposal to align and modernize how Medicare payments are tied to the cost of quality of patient care. The Notice of Proposed Rulemaking is the first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Currently, Medicare measures the value and quality of care provided by doctors and other clinicians through a patchwork of programs. Some clinicians are part of Alternative Payment Models such as the Accountable Care Organizations, the Comprehensive Primary Care Initiative, and the Medicare Shared Savings Program—and most participate in programs such as the Physician Quality Reporting System, the Value Modifier Program, and the Medicare Electronic Health Record (EHR) Incentive Program.

Congress streamlined these various programs into a single framework to help clinicians transition from payments based on volume to payments based on value. Today’s proposed rule would implement these changes through the unified framework called the Quality Payment Program, which includes two paths: The Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).